Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-27T00:40:30.119Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of online medical control on prehospital Code Stroke triage

Published online by Cambridge University Press:  21 May 2015

Aikta Verma ,
David J. Gladstone ,
Jiming Fang ,
Jordan Chenkin ,
Sandra E. Black  and
P. Richard Verbeek
Aikta Verma
Affiliation:
Division of Emergency Medicine, University of Toronto, Toronto, Ont.
David J. Gladstone
Affiliation:
Division of Neurology and Regional Stroke Centre, Sunnybrook Health Sciences Centre, Toronto, Ont. Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont. Heart and Stroke Foundation Centre for Stroke Recovery, Toronto, Ont.
Jiming Fang
Affiliation:
Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont.
Jordan Chenkin
Affiliation:
Division of Emergency Medicine, University of Toronto, Toronto, Ont.
Sandra E. Black
Affiliation:
Division of Neurology and Regional Stroke Centre, Sunnybrook Health Sciences Centre, Toronto, Ont. Heart and Stroke Foundation Centre for Stroke Recovery, Toronto, Ont.
P. Richard Verbeek*
Affiliation:
Division of Emergency Medicine, University of Toronto, Toronto, Ont. Sunnybrook Osler Centre for Prehospital Care, Sunnybrook Health Sciences Centre, Toronto, Ont.
*
Sunnybrook-Osler Centre for Prehospital Care, 10 Carlson Crt., Ste. 640, Toronto ON M9W 7K6; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Prehospital Code Stroke triage has the potential to overwhelm stroke centres by falsely identifying patients as eligible for fibrinolysis. We sought to determine whether online medical control (whereby paramedics contact the medical control physician before a Code Stroke triage is assigned) reduced the proportion of false-positive Code Stroke patients.

Methods:

Following the introduction of a protocol for prehospital Code Stroke triage in an urban centre, online medical control alternated with off-line medical control (whereby paramedics implement Code Stroke triage independently) over 4 discreet intervals. We reviewed data for patients triaged to 3 regional stroke centres to compare the proportion of false-positive Code Stroke patients during online versus off-line medical control. We predefined false positives as patients triaged as Code Stroke who had symptoms discovered on awakening, were last seen in their usual state of health greater than 2 hours before assessment or had a final diagnosis other than stroke.

Results:

The proportion of false positives was lower during online medical control (31% v. 42%, p = 0.003). This was explained by a lower proportion of patients whose symptoms were discovered on awakening (8% v. 14%, p < 0.001) and who were last seen in their usual state of health greater than 2 hours before assessment (22% v. 32%, p = 0.005). A final diagnosis of stroke was similar in the 2 groups (77% v. 79%, p = 0.39), as was the proportion of patients receiving fibrinolysis (35% v. 33%, p = 0.72). Eighteen percent of patients were denied Code Stroke triage during online control, most commonly because of the time of symptom onset.

Conclusion:

Online medical control is associated with a reduced proportion of false-positive Code Stroke triage.

Keywords

strokeemergency medical servicestriageparamedic
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 2 , March 2010 , pp. 103 - 110
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1.National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–7.CrossRefGoogle Scholar
2.Clark, WM, Wissman, S, Albers, GW, et al. Recombinant tissue-type plasminogen activator (Alteplase)for ischemic stroke 3 to 5 hours after symptom onset. The Atlantis study: a randomized controltrial. JAMA 1999;282:2019–26.Google Scholar
3.Marler, JR, Tilley, BC, Lu, M, et al. Early stroke treatment associated with better outcome. The NINDS rt-PA stroke study. Neurology 2000;55:1649–55.CrossRefGoogle ScholarPubMed
4.Hacke, W, Donnan, G, Fieschi, C, et al.; The ATLANTIS, ECASS and NINDS rt-PT Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS and NINDS rt-PA stroke trials. Lancet 2004;363:768–74.Google Scholar
5.Morgenstern, LB, Staub, L, Chan, W, et al. Improving delivery of acute stroke therapy: the TLL Temple Foundation Stroke Project. Stroke 2002;33:160–6.Google Scholar
6.Alberts, MJ, Hademenos, G, Latchaw, RE, et al. Recommendations for the establishment of primary stroke centres. JAMA 2000;283:3102–9.Google Scholar
7.CanadianStroke Strategy. Canadian best practice recommendations for stroke care: 2006. Ottawa (ON): Canadian Stroke Network; Heart and Stroke Foundation of Canada; 2006. Available: http://www.canadianstrokestrategy.ca/eng/resourcestools /documents/StrokeStrategyManual.pdf (accessed 2010 Jan 15).Google Scholar
8.Adams, HP Jr, Adams, RJ, Brott, T, et al. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the stroke council of the American stroke association. Stroke 2003;34:1056–83.Google Scholar
9.Schwamm, LH, Pancioli, A, Acker, JE III, et al. Recommendations from the American stroke association’s task force on the development of stroke systems. Stroke 2005;36:690–703.Google Scholar
10.Chenkin, J, Gladstone, D, Verbeek, P, et al. Predictive value of the Ontario prehospital stroke screening tool for the identification of patients with acute stroke. PrehospEmerg Care. 2009;13:153–9.Google Scholar
11.Kidwell, CS, Starkman, S, Eckstein, M, et al. Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke 2000;31:71–6.Google Scholar
12.Bray, JE, Martin, J, Cooper, G, et al. Paramedic identification of stroke: community validation ofthe Melbourne ambulance stroke screen. Cerebrovasc Dis 2005;20:28–33.Google Scholar
13.Registry of the Canadian Stroke Network. Progress report 2001-2005. Institute for Clinical Evaluative Sciences; 2005.Google Scholar
14.Hacke, W, Kaste, M, Bluhmki, E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N EnglJ Med 2008;359:1317–29.CrossRefGoogle ScholarPubMed
15.Lindsay, P, Bayley, M, Hellings, C, et al. Toward a more effective approach to stroke: Canadian Best Practice Recommendations for Stroke Care. CMAJ 2008;178:1418–25.Google Scholar